Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Aim To investigate the effects and signifi-cance of 5-HT2A receptor antagonist MDL1 1 939 on a-mice.Methods Kunming male mice were suffered a-cute acetic acid visceral pain,acute incision pain and CCI neuropathic pain.After each animal model was es-tablished,MDL1 1 939 was injected intraperitoneally. The writhing reaction was used to assess acute acetic acid visceral pain,while the thermal withdrawal laten-cy (TWL)was used to evaluate the acute incision pain and CCI neuropathic pain.Results Compared with the control group,MDL1 1 939 (0.25,0.5,1 .0 mg· kg -1 ,i.p.)relieved acetic acid visceral pain signifi-cantly in a dose-dependent manner in mice,as re-vealed by the significant reduction of the number of twisting.In acute incision pain and CCI neuropathic pain,MDL1 1 939 (0.5 mg·kg -1 ,i.p.)significantly increased TWL level.Conclusion 5-HT2A receptor antagonist MDL1 1 939 has analgesic effects on visceral pain,acute pain and neuropathic pain,which might be a novel therapeutic target to treat different pain in clini-cal situations.

Aim To explore the effect of activated SK channels(small conductance Ca2+-activated K+ channels) on morphine-induced hyperalgesia in the spinal cord in mice.Methods Adult C57BL6/N male mice were chosen to establish the model of morphine-hyperalgesia.The changes of tail withdrawal latency(TWL), mechanical withdrawal threshold(MWT) and the threshold of visceral pain were observed after intrathecal 1-EBIO, the agonist of SK channels.Results Compared with the control group, TWL, MWT and the threshold of visceral pain were decreased after morphine injection.After intrathecal 1-EBIO, the TWL, MWT and visceral pain threshold were increased.The level of spinal membrane SK2 expression in morphine-treated mice was decreased compared with that of control group.After intrathecal 1-EBIO, the level of spinal membrane SK2 expression was increased.Conclusion SK channels in the spinal cord are involved in morphine-induced hyperalgesia in mice.

Objective Todiscusstheangiographicfeaturesofhepaticneuroendocrineneoplasm(NEN),and to analyze the survival time of patients.Methods The clinical data of 60 patients with hepatic NEN were retrospectively reviewed.Transcatheter arterial chemoembolization (TACE),used as main therapy,was employed in 17 patients,22 patients received palliative treatment with no use of TACE,and 21 didn't receive any related treatment.The angiographic features of hepatic NEN were analyzed.Kaplan-Meier method was used to calculate the survival rate,and the survival prognostic factors were evaluated by Cox multivariate analysis method.Results Angiography showed that most neuroendocrine tumors (NETs) were characterized by hypovascular lesion,while neuroendocrine carcinomas (NECs) were manifested as hypervascular mass.The median overall survival time of 60 patients was 13.8 months.The 6-month,one-,2-and 3-year cumulative survival rates were 85.0％,52.0％,40.0％ and 33.8％,respectively.Cox regression analysis indicated that pathological grade of tumor (P=0.001) and treatment mode (P＜0.001) were the independent prognostic factors.Conclusion The rich or poor vascularity of hepatic NEN is helpful for the judgment of tumor grading.Patients whose hepatic NENs belong to high pathological grade (grade Ⅲ) usually have a poor prognosis.TACE is an effective therapy for hepatic NEN.

Objective To establish a simple and sensitive method for the determination of plasma drug concentration in rats after intragastrical and intravenous administration of paclitaxel loaded nanoparticles and to evaluate its pharmacokinetic characteristics .Methods AgilentTC-C18 column (250 mm × 4 .6 mm ,5 μm) was used for HPLC at the flow rate 1 ml/min with ketoconazole as internal standard and methanol acetonitrile water (45:20:35) as the mobile phase .The statistical mo-ment method was applied to calculate the pharmacokinetic parameters and to evaluate pharmacokinetic characteristics .Results There was a good liner relationship (r=0 .9997) when rat blood concentration of Paclitaxel ranged from 0 .5 to 20μg /ml .The accuracy and precision were in line with the requirements of biological sample analysis .The t1/2 were 3.86 ,3.76 ,3.35 and 2 .62 h after intravenous injection of three lab-made paclitaxel nanoparticles and paclitaxel solution via rat tail vein .The t1/2 were 5 .28 and 3 .72 h respectively after intragastrical administration of lab-made paclitaxel nanoparticles and paclitaxel suspen-sion .Conclusion This method can be used for the pharmacokinetic study of paclitaxel nanoparticles in rats .The paclitaxel loaded nanoparticles exhibited significantly longer in vivo retention time than paclitaxel injection and paclitaxel suspension .

Aim To explore the effect of pharmacolog-ical activation of serotonin 5-HT2C receptor (5-HT2C R) on naloxone-precipitated withdrawal in morphine-de-pendent mice. Method EthoVision Noldus video tracking system was used to record the effect of 5-HT2C R agonist WAY on locomotor activities and behavioral performances in mice.Results Selective 5-HT2C R ag-onist WAY (0.5,0.75 or 1 .0 mg·kg -1 ,i.p.)a-lone did not alter the locomotor activities as determined by distance traveled and velocity (all P values >0.05).Chronic morphine treatment induced depend-ence in mice as demonstrated by increases in distance traveled,velocity and jumping behavior.WAY (0.5, 0.75 or 1 .0 mg·kg -1 ,i.p.)and clonidine (0.2 mg ·kg -1 ,i.p.)significantly ameliorated naloxone-pre-cipitated withdrawal symptoms,including burrowing, jumping,body grooming,rearing,“wet dog”shakes, head shakes,face grooming,penile grooming,scratch (all P values <0.05).Conclusion Pharmacological activation of 5-HT2C R ameliorates naloxone-precipitated withdrawal symptoms in morphine-dependent mice.5-HT2C R may be a novel target to develop therapeutic ap-proach against morphine physical dependence,craving and relapsing.

Aim To examine subcellular localization of serotonin 5-HT2A receptor (5-HT2AR) and glutamate NMDA receptor in dorsal hippocampal CA1 area ( dCA1 ) and further explore the effect of systemic acti-vation of 5-HT2A R on hippocampal neuronal firing rate. Methods The distribution of 5-HT2A R and NMDA re-ceptor in the dCA1 region was detected with immune e-lectron microscopy after embedding. The effect of acti-vation of 5-HT2A R on the principal neuron and inter-neuron firing rates was examined with multichannel re-cording. Results 5-HT2A R immunoreactivity was ob-served in the dCA1 neurons, including rough endoplas-mic reticula and mitochondria, and the 5-HT2A R and glutamate NMDA receptors were colocalized in the syn-aptic membrane, vesicle and neurofilament of the hipp-ocampal neuron. 5-HT2A R activation increased princi-pal neuronal firing rate and the interneuronal firing rate was not changed. Conclusion The 5-HT2A R and NM-DA receptor are colocalized in dCA1 neurons, and acti-vation of 5-HT2A R increases hippocampal principal neuronal firing rate.

Based on a review of research and application of the clinical decision support system (CDSS) at home and abroad,a KB-CDSS building model is proposed.The authors rounded up the architecture,principle,process,construction of the knowledge base,system design and application value of the system.In the end,the paper introduced the application of WanFang Data Clinical Diagnosis and Treatment Knowledge Base.

Objective To investigate the effects of bisphenol A(BPA)exposure to perinatal on learning and memory behaviour in F1 generation male rats.Methods From the 11th day of gestation to the 7th day of field test was used to detect the locomotion activity,the Morris water maze was employed to measure learning and memory ability and long-term potentiation(LTP)were recorded to detect the synaptic plasticity in hippocampus CA1 with extracellular recording.Results The crossing number of BPA group(70.35±13.56)was much more than control group((29.32±14.12),P＜0.05).The number of standing up and ornament of BPA group((38.52±6.52),(6.26±2.78))were both higher than control group((10.35±8.38),(2.67±1.46),P＜0.05).BPA rats had longer escape latencies to find platform((55.22±5.78)s)than control rats((21.22±2.65)s,P＜0.05).Conditional protocol with high-frequency stimulation evoked a stable LTP in hippocampus CA1 region in control rats((162.13±10.12)%),however the LTP could not be induced with the same conditional protocol in BPA-exposed rats((101.05±7.58)%,P＜0.05).Conclusion Perinatal BPA exposure impaires learning and memory ability in F1 generation male rats related to presynaptic dysfunction.

AIM To study the role of serot on in (5-HT) in ventrolateral preoptic nucleus(VLPO) on sleep and wakefulness cycl e of rat by microinjection of 5-hydroxytryptaphan (5-HTP , precursor of 5-HT ) , non-special 5-HT receptor antagonist methysergide (MS) and 5-HT retake i nhibitor fluoxetine. METHODS Stereotaxic, microinjection and po lysomnography (PSG) were used in the experiment. RESULTS There was no significant effect by microinjection of 5-HTP(0 5 ?g,0 1 ?l) into VLPO,but microinjection of 5-HTP(1 ?g,0 1 ?l)and fluoxetine lead wake i ncreased and sleep decreased; while microinjection of non-selective serotonin receptor antagonist MS lead to the opposited effect. The chang of sleep-wakefu lness cycle caused by 5-HTP or MS were significantly assiociated with time. CONCLUSION 5-HT involved in the regulation of sleep-wake cycle a nd promoted wake in the VLPO and its role of promotion may involve the gene exp ression of post-synaptic neurons.